Internal Medicine Coding Alert

Published on Mon Feb 01, 2010 PDF

Most beneficiaries can receive a test with V73.89.

CMS is opening the door for just about all beneficiaries to receive annual HIV tests -- but it has identified specific risk factors to detail in reporting.

The US Preventive Services Task Force (USPSTF) guided CMS to identify eight increased-risk criteria for HIV screenings. The first seven require the presence of both ICD-9 diagnosis codes V73.89 (Special screening for other specified viral disease) and V69.8 (Other problems related to lifestyle) for the claim to be paid.

Persons at increased risk include:

1. men who have had sex with men after 1975

2. men and women having unprotected sex with multiple (more than one) partners

3. past or present injection drug users

4.men and women who exchange sex for money or drugs, or have sex partners who do

5. individuals whose past or present sex partners were HIV-infected, bisexual, or injection drug users

6. persons being treated for any sexually transmitted diseases

7. persons with a history of blood transfusion between 1978 and 1985.

The last criterion, which covers persons reporting no increased risk factors, only requires ICD-9 V73.89 for the claim to be paid:

8.persons who request an HIV test despite reporting no individual risk factors, since this group is likely to include individuals not willing to disclose their highrisk behaviors.

"I think they are allowing for some physician discretion in ordering a test on someone that does not admit to anything, rather than opening the door for 'everyone' [to get a test]," comments Jill Young, CPC, CEDC, CIMC, with Young Medical Consulting LLC in East Lansing, Mich.

Findings: To report test results, counsels Young, choose among the following:

• 795.71 -- Nonspecific serologic evidence of human immunodeficiency virus (HIV), if results are inconclusive

• V65.44 -- Human immunodeficiency virus [HIV] counseling, if test results are negative

• V08 -- Asymptomatic human immunodeficiency virus (HIV) infection status, if results are positive but the patient is asymptomatic

• 042 -- Human immunodeficiency virus (HIV) disease, if the patient is symptomatic.

Exclusion: Patients with any known prior diagnosis of HIV-related illness are not eligible for this screening test.

Resource: www.cms.hhs.gov/transmittals/downloads/R1935CP.pdf